physicians billing consults on midwife pts


Best answers
Our obgyn docs also have employed midwives in the office. We are having a dispute in the office.

The docs are billing for a consult when they see a midwife patient (ie. visit in the office to discuss surgery, or hospital visit due to delivery complication).

I was always under the impression that you could not bill for a consult on an existing patient in your practice. Isn't this true. I really can't find anything literature on it, and I don't think the CPT book really addresses that.

Any help you could give me to show them would be greatly appreciated! Thanks:p


Shoreview, MN
Best answers
You can bill a consult within the same office if the consulting provider has an area of expertise that the requesting provider does not.

In your example, ask yourself the question, "What is the intent of the physician's visit ?" If the physician is seeing the midwife's patient because they share OB visits in your office and whomever is available for that patient's appt, then it is not a consult; just a regular OB visit.

If your midwife has a patient concern that she/he does not know how to address and asks the physician for an opinion, then it can be a consult.

If the physician sees the patient to discuss surgery, that is included in the global package and definitely is not a consult, but just an OB visit.

A hospital visit due to delivery complications could be a consult if the midwife requested an opinion; but if the physician is On Call to see OB patients, not a consult but could be a subsequent visit based on documentation.

I hope this helps.